Assessment of the Head, Face

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Assessment of the Head, Face Neck

• Dr. Sara Mitchell
• Georgia Baptist College of Nursing
• Of Mercer University

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Main bones of the cranium

• __________
• __________
• __________
• __________

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Major structures of the neck

• __________________
• __________________
• __________________
• ________________
• _____________
• _______________
• _______________

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Midline structures of the neck

• _________________________________
• _________________________
• __________________
• __________________
• __________________

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Assessment of the head

• Inspect
• hair
• scalp
• skull
• face
• skin

• Palpate
• scalp
• skull
• temporal artery

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How to Examine the Hair and Scalp
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Assessment of the face

• CN V - __________
• motor function
• sensory function
• CN Vll - ________
• motor function
• sensory function
• CN lX X - ___________ ____

• CN Xl - ___________
• CN Xll - __________

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Assessment of the cranial sinuses

• The paranasal sinuses are air filled cavities
  that warm, moisten, filter air, and aid in voice
  resonance

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Assessment of sinuses
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How to Examine CN V Trigeminal Nerve Sensory
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How to Examine CN V Trigeminal Nerve Motor
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CN VII Facial Motor
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The Mouth

• A part of face through which food passes into
  the body, being within the tongue, gums, and teeth

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The oral pharynx

• Composted of three functional parts
• __________________
• __________________
• __________________
• Functions include
• _____________
• _____________
• _____________

Oropharynx
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Oral mucosa Assessment

• Inspect
• lips
• oral mucosa
• gums teeth
• roof of mouth
• tongue floor of mouth
• pharynx

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Tonsils
Strep Tonsillitis
Peritonsillar Abscess
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Hand Foot Mouth Disease
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(No Transcript)
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The Tongue

• Contains the strongest muscle in the body
• Innervated by the __________ or twelfth cranial
  nerve (CN XII)
• Sweet salty tastes are perceived on the
  anterior two thirds of the supplied by a division
  of the ________ or cranial nerve seven (CN VII)
• Sour bitter tastes are perceived at the
  posterior aspect of the tongue which is
  innervated by the _____________ or ninth cranial
  nerve (CN IX)

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Assessment of tongue

• Inspect
• General appearance
• Mucosa
• Palpate
• Lateral margins
• All white lesions

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Normal tongue variants
Geographic tongue
Black hairy tongue
Fissured Tongue
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The salivary glands

• There are three major salivary glands
• ________________
• ________________
• ________________
• ____________ arises from the parotid gland
• ___________ duct arises from the submandibular
  gland

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The Neck
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Assessment of the neck

• The neck can tilt to one side or the other about
  45 degrees. (The lumbar spine, by comparison, can
  only tilt to between 15 and 20 degrees.)
• The neck can extend, or bend backwards, about
  70 to 90 degrees. (By comparison the low back can
  flex only 40 to 60 degrees.)
• The neck can flex, or bend forward, about 80 to
  90 degrees. (The low back can only extend 20 to
  25 degrees.)
• Our necks need to use their mobility in order to
  maintain it. They work best when they can
  consistently move into and out of their full
  range of motion in a gentle - that is, not a
  jarring - way.

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Assessment of the neck

• Inspection
• general
• specific (thyroid)
• Range of motion

lumbar spine can only rotate 3 to 18 degrees.)
                                                  
                                                  
                                           
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Functions Lymphatic System

• Filters and engulfs bacteria, certain other
  cells, foreign particles, or toxins in the lymph
  nodes
• Returns fluid, proteins, and electrolytes from
  tissue space to the blood.
• Absorbs fat and fat-soluble substances from the
  intestinal tract
• Produces lymphocytes in the lymph nodes, tonsils,
  adenoids, spleen, and bone marrow
• Produces antibodies
• The lymphatic system is also a pathway for the
  spread of malignancy

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Assessment of the lymph nodes

• Use a _____________ to palpate each anatomical
  area that housed lymph nodes
• All palpable nodes should be assessed for ______,
  ______,_________, and _______________.

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Common infectious causes of cervical
lymphadenopathy

• Group A streptococcal infection
• Mononucleosis (Ebstein Barr Virus, or EBV)
• Cytomegalovirus (CMV, closely related to EBV)
• HIV

• Unusual infectious causes include
• Cat scratch disease (usually from a kitten)
• Tularemia (ask about hunting rabbits)
• Anthrax
• Lupus

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The Thyroid Gland

• The largest endocrine gland in the body and the
  only one that is accessible to direct physical
  assessment.
• Butterfly shaped with a lobe on each side of the
  trachea
• Normal consistency described as meaty or
  rubbery

isthumus
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Assessment of the thyroid gland

• Unusual __________ is associated with cancer or
  scarring
• ____________ or sponginess is seen with toxic
  goiter
• ____________ is associated with acute infection
  or hemorrhage
• __________________________________________________
  _______________________________

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Palpation of Thyroid Gland in Client with Goiter

• When auscultating the thyroid listen for the
  presence of a bruit.
• The finding of a systolic or to-to-fro thyroid
  bruit, is highly suggestive of a toxic goiter

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Causes of Enlarged Thyroid

• Graves Disease
• Hashimotos disease
• Multinodular goiter
• Solitary thyroid nodules
• Thyroid cancer
• Pregnancy
• Inflammation

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Sternocleidomastoid Muscle

• The sternocleidomastoid muscle is innerved by the
  ___________or eleventh cranial nerve
• Anterior to this muscle is the anterior triangle
  bounded by the clavicle anteriorly and midline

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How to Examine CN XI Spinal Accessory
Trapezius Muscle

• Posterior to the muscle is the posterior triangle
  bounded by the trapezius muscle posteriorly and
  the clavicle inferiorly.

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The Ears
Ouch! Let Go
Come on, lets play
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The Ear

• Ear structure
• external ear
• _______________
• middle ear
• _______________
• inner ear
• ________________l

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Assessment of the Ear

• External Ear
• Inspection
• auricles and mastoid area for
• Tenderness
• Swelling
• Nodules

• Internal Ear
• Structures - video
• tympanic membrane
• hearing
• AC vs. BC

video
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Correct handling of the Otoscope

• For children under 3 years of age place the pinna
  should be pulled ____________
• For children older than 3 as well as adults,
  pinna should be pulled __________

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The Tympanic Membrane
Injected Tympanic Membrane
Normal right tympanic membrane
Ventilation Tube
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Rinne Test

• The Rinne evaluates air conduction and bone
  conduction
• The client who has no conductive hearing loss
  will hear the sound ______ as long ____ by _____
  condition as by ____ conduction ________

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The Weber test

• This test compares bone conduction in both ears
  and determines whether monaural impairment is
  neural or conductive.
• Sound should be heard equally in both ears.
• Hearing that is ________ is associated with
  ______ ______

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Impact of Hearing Loss

• Paranoia
• Withdrawal
• Depression
• Anxiety

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Oh you men that think that I am malevolent, or
misanthropic, how greatly do you wrong me. You do
not know the secret cause which makes me seem
that way to you For me there can be no
relaxation with my fellow men, no refined
conversations, no mutual exchange of ideas. I
must live alone, like one who has been banished
What a humiliation for me when someone standing
next to me heard a flute in the distance, and I
heard nothinga little more of that and I would
have ended my life it was only my art that held
me back Beethoven
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Differential Diagnoses for Hearing Loss

• Children
• Congenital
• Acquired

• Adults
• Acquired

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The Nose
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Assessment of olfactory ability
_______________________________
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Nose assessment

• Inspection
• Nose parasinuses
• anterior posterior surfaces
• test for nasal obstruction
• inside of nose
• mucosa
• turbinates
• Palpate
• sinuses
• transillumination

Nasal speculum
Normal Nasal Turbinates
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Assessment of the external nose

• Common condition of external nose
• Rhinophyma (with or without rosacea

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Differential Diagnoses of abnormal nasal findings

• URI
• Allergies
• Epitasis
• Polyps

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Review of cranial nerves in order

• I Olfactory - smell
• II Optic - vision
• III Oculomotor Most EOM movement raise
  eyelids pupil constriction
• IV Trochlear superior oblique
• V Trigeminal mastication facial scalp
  sensation
• VI Abducens lateral rectus
• VII Facial facial muscles taste saliva
  tear secretion

• VIII Acoustic hearing equilibrium
• IX Glossopharyngeal phonation swallowing
  taste back portion of tongue
• X Vagus talking swallowing carotid reflex
• XI Spinal Accessory movement of trapezius
  sternomastoid muscle
• XII Hypoglossal movement of tongue

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H(E)ENT S.O.A.P. note

• Subjective - chief complaint and related history
  (ask yourself is this concern specific to HEENT
  or related to a systemic illness?)
• Objective -
• general
• ENT
• Neck
• Assessment -
• Plan -

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Our eyes, ears, nose allow us to experience the
beauty of creation